# Mechanisms and Severity of Injuries in Infants and Children <2 Years: A Retrospective Analysis over 30 Years in a European Urban Level 1 Trauma Center

## TL;DR

This study examines injury patterns in infants and children under two years, showing how development affects injury types and severity over time.

## Contribution

The study provides a large-scale, infant-specific analysis of injury mechanisms and outcomes in a European trauma center over 30 years.

## Key findings

- Head injuries were most common in infants, while wounds and fractures increased in children aged 12–24 months.
- Falls were the leading cause of injury across both age groups, with most cases treated conservatively.
- Only 0.8% of cases required surgery, primarily for wounds and fractures.

## Abstract

Background/Objectives: Injuries remain a major cause of childhood morbidity and mortality in Europe, despite improved prevention. Infants under one year are particularly vulnerable because of limited motor control and complete dependence on caregivers. Existing studies are often small or cover broad age ranges, limiting infant-specific insights. This study aims to provide a comprehensive overview of injury types, mechanisms, and treatments, focusing exclusively on infants aged zero to one year. Methods: This retrospective study analyzed 29,574 infants and children (<2 years) treated at a level 1 trauma department from 1993 to 2022. Primary data included main diagnosis, injury mechanism, and treatment. Injuries were classified by diagnosis and mechanism. Surgeries were categorized by procedure type. Results: Injury frequency increased with age. A total of 31.1% of cases occurred in infants (<12 months) and 68.9% in children (12–24 months). Head injuries were the most common trauma type (44%), particularly among infants (69.9%; children: 32.2%), while wounds (infants: 10.2%; children: 31.5%) and fractures (infants: 4.2%; children: 8.4%) were more frequent in children. Falls were the predominant mechanism (77.9%) across both groups. Most injuries were treated conservatively. A total of 228 surgical interventions were performed (0.8%), mainly for wounds (54.8%) and fractures (30.3%). Conclusions: This study shows that, even within the first two years of life, child development shapes both injury frequency and type. As mobility and independence increase, injuries rise, from predominantly head trauma among infants to a higher incidence of wounds and fractures in children. The majority of injuries were minor and managed conservatively.